Meet the Expert

En español l Every doctor goes through a transformation from physician to healer. In medical school, we memorize and regurgitate information; as interns and residents, we strain to learn every new procedure. As young doctors, we keep patients at arm's length and try simply to cure them.

We can't know then what we will come to realize later in life — that our professors are just laying the brickwork, and that our real teachers are our patients.

One such patient, Lindsay Nohr, will always stand out in my mind, not only because of her circumstances, but because she forever changed the way I practice medicine.

The year was 1999, and I was well into my career as a head and neck surgeon in San Francisco. When Lindsay first walked into my medical practice, I was immediately struck by her beauty — she was athletic, with porcelain skin and fierce, bright eyes. She also had a lump on the right side of her tongue, and unlike a canker sore or an accidental bite, it wasn't going away. This is never a good sign, but in a young person — Lindsay was 22 at the time — a cancer of the tongue can be a death sentence.

As it turned out, Lindsay indeed had tongue cancer, and I knew she was going to need surgery, radiation treatments and most likely chemotherapy. None comes without a significant downside. Take out too little of the tongue and the cancer recurs. Take out too much and a person will never speak normally again.

Radiation kills cancer cells, but it kills normal cells, too, and that meant Lindsay's flawless skin was going to become fire-poker red and be painful to the touch. Most likely, chemotherapy would bring on nausea and vomiting, cause her hair to fall out and make her feel like hell.

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Lindsay sat in stunned silence for a few seconds, then turned and asked me a question I wasn't expecting: "Will any of this interfere with my chances of having a family later?"

Having a family? Had she been listening?

She was unmarried, was facing a formidable challenge, and she didn't know what I knew. The week before we met, a report in a medical journal had addressed the dismal survival rates for young people with mouth and tongue cancer who didn't have any other cancer risks. The journal could just as well have had Lindsay's picture on the cover.

I looked directly into her eyes and said firmly: "Lindsay, I'm not concerned about the fact that you might want to have a baby in five years. I'm worried that you might not be here in five years."

She didn't even blink.

After helping her get a second opinion at one of the country's most respected cancer centers, I thought I'd never see Lindsay again. But she called several days later, crying, wanting to come home and begin the first step on her journey: aggressive radiation therapy. Although the treatment worked for a while, the cancer returned in her neck, requiring surgery, more radiation and, then, the dreaded chemotherapy.

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